1 Zimmermann C, et al. BMJ Supportive & Palliative Care 2021;0:1–11. doi:10.1136/bmjspcare-2021-003340 Public knowledge and attitudes concerning palliative care Camilla Zimmermann , 1,2,3,4,5,6 Joanne L. Wong, 1 Nadia Swami, 1 Ashley Pope, 1 YiQin Cheng, 1 Jean Mathews, 1,5 Doris Howell, 1,3,7,8 Richard Sullivan, 9 Gary Rodin , 1,3,6,8 Breffni Hannon , 1,2,4,5 Rahim Moineddin, 8,10 Lisa W. Le 11 To cite: Zimmermann C, Wong JL, Swami N, et al. BMJ Supportive & Palliative Care Epub ahead of print: [please include Day Month Year]. doi:10.1136/ bmjspcare-2021-003340 ► Additional supplemental material is published online only. To view, please visit the journal online (http://dx.doi. org/10.1136/bmjspcare-2021- 003340). For numbered affliations see end of article. Correspondence to Dr Camilla Zimmermann, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; camilla.zimmermann@uhn.ca Received 23 August 2021 Accepted 31 August 2021 Original research © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. ABSTRACT Objective WHO recommends early integration of palliative care alongside usual care to improve quality of life, although misunderstanding of palliative care may impede this. We compared the public’s perceived and actual knowledge of palliative care, and examined the relationship of this knowledge to attitudes concerning palliative care. Methods We analysed data from a survey of a representative sample of the Canadian public, accessed through a survey panel in May–June 2019. We compared high perceived knowledge (‘know what palliative care is and could explain it’) with actual knowledge of the WHO defnition (knew ≥5/8 components, including that palliative care can be provided early in the illness and together with life-prolonging treatments), and examined their associations with attitudes to palliative care. Results Of 1518 adult participants residing in Canada, 45% had high perceived knowledge, of whom 46% had high actual knowledge. Participants with high (vs low) perceived knowledge were more likely to associate palliative care with end-of-life care (adjusted OR 2.15 (95% CI 1.66 to 2.79), p<0.0001) and less likely to believe it offered hope (0.62 (95% CI 0.47 to 0.81), p=0.0004). Conversely, participants with high (vs low) actual knowledge were less likely to fnd palliative care fearful (0.67 (95% CI 0.52 to 0.86), p=0.002) or depressing (0.72 (95% CI 0.56 to 0.93), p=0.01) and more likely to believe it offered hope (1.88 (95% CI 1.46 to 2.43), p<0.0001). Conclusions Stigma regarding palliative care may be perpetuated by those who falsely believe they understand its meaning. Public health education is needed to increase knowledge about palliative care, promote its early integration and counter false assumptions. INTRODUCTION Timely access to palliative care is an urgent public health concern, for which misunderstanding of the meaning of palli- ative care and its persistent conflation with end-of-life care represent fundamental barriers. 1 Two decades ago, WHO rede- fined palliative care with an emphasis on improving quality of life for those facing life-threatening illnesses through early identification and proactive treatment of physical, psychosocial and spiritual prob- lems. 2 This definition is supported by recent high-level evidence demonstrating that early involvement of specialised palli- ative care alongside treatments aimed at prolonging life results in improved quality of life, symptom control and satisfaction with care. 3–6 Clinical practice guidelines now recommend the routine involvement of palliative care teams from the time of diagnosis of advanced disease in patients with cancer and other chronic illnesses. 7 8 Despite these guidelines, early palli- ative care integration does not occur Key messages What was already known? ► Previous surveys have demonstrated low levels of public knowledge about palliative care. What are the new fndings? ► In this national survey of 1518 adults, those with greater perceived knowledge of palliative care had more negative attitudes about palliative care, whereas those with greater actual knowledge viewed it more positively. What is their signifcance? ► Clinical – Stigma regarding palliative care may be perpetuated by those who falsely believe they understand its meaning. ► Research – Public health education is warranted to reduce misperceptions associated with palliative care. Protected by copyright. on October 8, 2021 at King's College London. http://spcare.bmj.com/ BMJ Support Palliat Care: first published as 10.1136/bmjspcare-2021-003340 on 7 October 2021. Downloaded from